796 
DISEASES OF THE FOOT. 
of pus cocci in the parachondrium. These comprise :—Injection with 
disinfectants. Liquor Villati has for many years enjoyed a wide reputa¬ 
tion for this purpose. Williams recommends 10 per cent, watery solution 
of corrosive sublimate, to which a few drops of hydrochloric acid have 
been added to ensure complete solution. Carbolic acid has also been 
employed. In using these, the principal point is to bring them intimately 
into contact with the diseased membrane. For this reason it is best to 
first inject into the sinus, by means of a small lead syringe, some clean 
water or carbolic solution to, as far as possible, remove pus, a process 
which can be aided by gentle pressure. Then follows an injection with 
the active agent, which may be either liquor Yillati, 5 per cent, carbolic 
acid, 10 per cent, chloride of zinc, or corrosive sublimate. To ensure 
the solution reaching the bottom of the fistula, the syringe should be 
provided with a long, thin nozzle. 
The injections must be made daily, and continued until they cause 
considerable pain, when they are discontinued for a time and again 
resorted to until suppuration altogether ceases. Sometimes after a few 
days the swelling diminishes and pus ceases to be discharged, both 
favourable symptoms, as they point to commencing healing. 
When the sinus is old, deep, or very oblique, and especially if it extends 
below the coronet, it is advisable to make a counter-opening. The 
coronary band should not be divided. After thoroughly thinning the 
wall a grooved director is passed to the bottom of the sinus, the wall 
divided from without, a small fragment of the tissue of the wall removed, 
and a short length of gauze passed through the sinus and tied, to secure 
it in position. Sometimes two sinuses exist, and require the insertion of 
two drains. 
Winkler recently recommended spirituous sublimate solutions, followed 
at a later stage by acetate of lead, also dissolved in spirit. He avoids 
using water. 
Gamgee’s mixture has again come into some favour. It consists of 
sublimate 17 parts, acetate of lead 84 parts, spirit 186 parts, hydrochloric 
acid 2 parts. After clipping away the hair and enlarging the fistulge, a 
dry dressing is applied. On the second or third day, and again on the 
fourth, fifth, and sixth, the parts are injected. From the seventh day 
onwards, the openings of the fistulae on the coronet are only disinfected 
and a dressing applied. In a fortnight recovery is said to take place 
(Walter). To protect himself against the escaping fluid, the operator 
may wind a thick piece of tow around the tube of the syringe. Giesecke 
recommends a 5 to 20 per cent, solution of protargol. 
If the canal be too narrow to allow a syringe to enter, a small fragment 
of sublimate, or a thread soaked in sublimate solution, may be passed to 
the bottom, a method of treatment which is especially useful in old sinuses 
